Chest
Volume 148, Issue 4, October 2015, Pages 870-876
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Original Research
Asthma
Dedicated Severe Asthma Services Improve Health-care Use and Quality of Life

https://doi.org/10.1378/chest.14-3056Get rights and content

BACKGROUND

Systematic assessment of severe asthma can be used to confirm the diagnosis identify comorbidities, and address adherence to therapy. However, the prospective usefulness of this approach is yet to be established. The objective of this study was to determine whether the systematic assessment of severe asthma is associated with improved quality of life (QoL) and health-care use and, using prospective data collection, to compare relevant outcomes in patients referred with severe asthma to specialist centers across the United Kingdom.

METHODS

Data from the National Registry for dedicated UK Difficult Asthma Services were used to compare patient demographics, disease characteristics, and health-care use between initial assessment and a median follow-up of 286 days.

RESULTS

The study population consisted of 346 patients with severe asthma. At follow-up, there were significant reductions in health-care use in terms of primary care or ED visits (66.4% vs 87.8%, P < .0001) and hospital admissions (38% vs 48%, P =.0004). Although no difference was noted in terms of those requiring maintenance oral corticosteroids, there was a reduction in steroid dose (10 mg [8-20 mg] vs 15 mg [10-20 mg], P =.003), and fewer subjects required short-burst steroids (77.4% vs 90.8%, P =.01). Significant improvements were seen in QoL and control using the Asthma Quality of Life Questionnaire and the Asthma Control Questionnaire.

CONCLUSIONS

To our knowledge, this is the first time that a prospective study has shown that a systematic assessment at a dedicated severe asthma center is associated with improved QoL and asthma control and a reduction in health-care use and oral steroid burden.

Section snippets

Results

Baseline demographics are shown in Table 1. TABLE 2, TABLE 3, TABLE 4 compare baseline and follow-up visits in terms of lung function, health-care use, corticosteroid use, and QoL.

The study used a minimum follow-up period of 100 days, with a range of 100 to 833 days and a median value of 286 days. Table 5 divides the cohort into tertiles (1 = shortest and 3 = longest follow-up period) according to the time between baseline and follow-up. Values are presented as No. (%) or median (interquartile

Discussion

The usefulness of a systematic assessment for severe asthma was first evaluated in 1993. A study of 42 patients with difficult-to-control asthma (defined as requiring > 10 mg of prednisolone every other day for ≥ 3 consecutive mo/y) found that following a series of investigations, 31 were deemed no longer difficult to control.7 In addition, it identified two or more contributing factors to the asthma in 80% of subjects. Subsequent studies looking at a systematic assessment have noted similar

Acknowledgments

Author contributions: A. N. M.-G. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. D. G., L. G. H., C. E. Brightling, R. N., A. H. M., R. C., C. E. Bucknall, and A. N. M.-G. contributed to the study planning and conduct; D. G. contributed to the presentation of plans and data to the group; D. G. and A. N. M.-G. contributed to the data abstraction and

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FUNDING/SUPPORT: The authors have reported to that no funding was received for this study.

originally published Online First March 19, 2015.

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